Issues in Ethics: Competition in Professional Practice
About This Document
Published 2017. This Issues in Ethics statement is a revision of Competition in Professional Practice (2011), which revised Competition (2004). It has been updated to make any references to the Code of Ethics consistent with the Code of Ethics (2016). The Board of Ethics reviews Issues in Ethics statements periodically to ensure that they meet the needs of the professions and are consistent with ASHA policies.
Issues in Ethics Statements: Definition
From time to time, the Board of Ethics (hereinafter, the "Board") determines that members and certificate holders can benefit from additional analysis and instruction concerning a specific issue of ethical conduct. Issues in Ethics statements are intended to heighten sensitivity and increase awareness. They are illustrative of the Code of Ethics (2016) (hereinafter, the "Code") and are intended to promote thoughtful consideration of ethical issues. They may assist members and certificate holders in engaging in self-guided ethical decision making. These statements do not absolutely prohibit or require specified activity. The facts and circumstances surrounding a matter of concern will determine whether the activity is ethical.
Introduction
The Board has received inquiries and comments regarding ethical behavior among members and certificate holders who compete for the opportunity to provide services to clients. Audiologists and speech-language pathologists are involved in marketing their services, advertising, negotiating contracts, recruiting and hiring staff, establishing fees, dispensing products, working with manufacturers and publishers to offer various products to clients, and other practice management activities. Competition for business in the marketplace influences these activities and how we engage in them. A related topic is addressed in another Issues in Ethics statement, Public Announcements and Public Statements.
Discussion
The Code provides us with guidance as we competitively design and market services, as well as guidance regarding our responsibility to the public and our professional relationships. It also guides our conduct as we engage in professional practice and function in the professional community. The Code also gives guidance concerning misrepresentation, deceit, and dishonesty. The Code embodies concepts and requirements to be considered in practice management as it relates to competition for business in the marketplace.
There are two overarching principles that relate to competition:
Principle of Ethics I states, "Individuals shall honor their responsibility to hold paramount the welfare of persons they serve professionally or who are participants in research and scholarly activities, and they shall treat animals involved in research in a humane manner."
Principle of Ethics III states, "Individuals shall honor their responsibility to the public when advocating for the unmet communication and swallowing needs of the public and shall provide accurate information involving any aspect of the professions."
Both of these principles indicate that audiologists and speech-language pathologists should consider the welfare of the persons they serve as their most important commitment. Our responsibility to the public is clear: Services must be designed to serve the public by providing accurate information in all aspects of our professions. Although competition is healthy, any manifestation of competition must be accurate and presented in a way that is not detrimental to the professions.
In attempting to obtain a competitive advantage, individuals must handle many issues including, but not limited to, referrals, representation of services, statements about services/products, and conduct that reflects positively on the professions as we engage in practice matters. The Code addresses our professional relationships as well as our treatment of each other as we engage in professional practice and function in the professional community. These rules can help guide us as we engage in activities and relationships that involve competition.
Principle of Ethics IV states, "Individuals shall uphold the dignity and autonomy of the professions, maintain collaborative and harmonious interprofessional and intraprofessional relationships, and accept the professions’ self-imposed standards."
This principle indicates that professionals must maintain well-balanced, collegial relationships with colleagues. As we compete with other professionals, whether within or outside our disciplines, we must compete in a dignified manner that exemplifies our professional standards.
Principle of Ethics I, Rule Q states, "Individuals shall maintain timely records and accurately record and bill for services provided and products dispensed and shall not misrepresent services provided, products dispensed, or research and scholarly activities conducted." It is important to keep this rule in mind as we market our services and products to ensure that there is no distortion of facts in client/practice information, advertisements, or claims.
Other Code provisions that address competition are Principle of Ethics III, Rules B, D, E, and F.
- Rule B states, "Individuals shall avoid engaging in conflicts of interest whereby personal, financial, or other considerations have the potential to influence or compromise professional judgement and objectivity."
- Rule D states, "Individuals shall not defraud through intent, ignorance, or negligence or engage in any scheme to defraud in connection with obtaining payment, reimbursement, or grants and contracts for services provided, research conducted, or products dispensed."
- Rule E states, "Individuals’ statements to the public shall provide accurate and complete information about the nature and management of communication disorders, about the professions, about professional services, about products for sale, and about research and scholarly activities."
- Rule F states, "Individuals’ statements to the public shall adhere to prevailing professional norms and shall not contain misrepresentations when advertising, announcing, and promoting their professional services and products and when reporting research results."
These rules relate to misrepresenting services as well as engaging in deceptive schemes. While we compete for clients/patients, we must be open and honest about the services we provide, the charges that will be incurred, and procedures for obtaining payment from third parties or clients, as we market our services to the public. In addition, these rules mandate accuracy and transparency of all information provided to the public.
Several rules address misrepresentation, negligence, fraud, deceit, and dishonesty. They include Principle of Ethics I, Rule Q; Principle of Ethics III, Rules C, D, and F; and Principle of Ethics IV, Rule E, which states, "Individuals shall not engage in dishonesty, negligence, fraud, deceit, or misrepresentation." The clinician must be honest in written and verbal statements to the public and to other professionals, including advertising and promotional materials.
With regard to referrals, Principle of Ethics III, Rule B states, "Individuals shall avoid engaging in conflicts of interest whereby personal, financial, or other considerations have the potential to influence or compromise professional judgement and objectivity." It is imperative that practitioners hold paramount the welfare of the persons being served when making referrals.
In attempting to gain a competitive edge, we must adhere to the following rules regarding accuracy of statements made in writing or verbally.
- Principle of Ethics I, Rule L states, "Individuals may make a reasonable statement of prognosis, but they shall not guarantee—directly or by implication—the results of any treatment or procedure."
- Principle of Ethics III, Rule A states, "Individuals shall not misrepresent their credentials, competence, education, training, experience, and scholarly contributions."
- Principle of Ethics III, Rule D states, "Individuals shall not defraud through intent, ignorance, or negligence or engage in any scheme to defraud in connect with obtaining payment, reimbursement, or grants and contracts for services provided, research conducted, or products dispensed."
- Principle of Ethics IV, Rule C states, "Individuals' statements to colleagues about professional services, research results, and products shall adhere to prevailing professional standards and shall contain no misrepresentations."
- Principle of Ethics IV, Rule O states "Individuals shall not file or encourage others to file complaints that disregard or ignore facts that would disprove the allegation; the Code of Ethics shall not be used for personal reprisal, as a means of addressing personal animosity, or as a vehicle for retaliation." However, Rule O does not obviate the necessity of adhering to Principle of Ethics I, Rule S should the circumstances arise. Rule S states, "Individuals who have knowledge that a colleague is unable to provide professional services with reasonable skill and safety shall report this information to the appropriate authority, internally if a mechanism exists and, otherwise, externally."
These rules indicate that honesty and truthfulness are of utmost importance when discussing our services with clients and other professionals. Successful competition may require that we set ourselves apart from competitors, but accuracy and truthfulness should prevail.
Together these Principles and associated Rules of Ethics embody concepts and requirements to be considered in practice management and competition for business in the marketplace.
Guidance
Competition among service providers is not unethical. When handled properly, competition can lead to positive growth and continued improvement in the quality of services delivered by audiologists and speech-language pathologists. It is expected that audiologists and speech-language pathologists will be involved in marketing services, bidding on contracts, and competing for business in appropriate ways. It is incumbent on the individual to be aware of legal requirements that guide competition and practice management in the marketplace. Finally, it is essential that the quality of services to clients not be adversely affected by competition for the opportunity to provide those services.
